RU2308199C2 - Enteral alimentation food "nutrient gepa" - Google Patents

Abstract

FIELD: milk industry, in particular, products for tube and oral alimentation for grownups and children of three years and older.

SUBSTANCE: enteral alimentation food contains whey protein concentrate, 1-isoleucine, 1-leucine, 1 valine amino acids, maltodextrin, sugar, mid-chain triglycerides concentrate, rapeseed oil, soya oil, with weight ratio of mid-chain triglycerides concentrate, soya and rapeseed oils making 2:1:1, respectively, emulsifier, mineral substances, vitamins and water.

EFFECT: increased nutrient value, improved prophylactic properties, and high quality of product.

1 tbl, 9 ex

Description

The invention relates to the dairy industry, namely the production of dairy products of probe and oral nutrition for adults and children 3 years of age and older, used as additional or main nutrition for liver failure.

Known dry milk product for enteral and oral nutrition "Alitraq ^® "("Alitrack ^® "), manufactured by Abbot Laboratories, USA, containing enzymatic hydrolysates of soy protein and whey, milk whey protein concentrate, a mixture of amino acids including branched chain (valine , leucine, isoleucine) and aromatic amino acids (tyrosine, tryptophan, phenylalanine), a fraction of medium chain triglycerides, safflower oil, maltodextrin, sugar, fructose, mineral salts, fat and water soluble vitamins and water [1]. This product is used for impaired digestion and absorption in chronic bowel disease, with stress.

The protein component of this product is unacceptable for liver patients due to the excess of aromatic amino acids in it and the lack of branched chain. In addition, the total amount of protein is too large for hepatic patients. With liver failure, firstly, the ability of the liver to process ammonia coming from the portal vein blood into urea decreases sharply. As a result of this, poisoning of the body with ammonia occurs. In order to prevent this, the total protein content should be reduced in the diet of patients (up to 10-12% of the total calorie content). Secondly, due to the inability of the liver to process aromatic amino acids (phenylalanine, tyrosine and tryptophan), these amino acids, as well as the so-called "pathological" (that is, absent in the norm) products of their metabolism, accumulate in the blood. All these substances can penetrate the blood-brain barrier into the brain and have the effect of so-called "false neurotransmitters", that is, disrupt the central nervous system. As a result, the patient develops a severe brain damage (hepatic encephalopathy, hepatic coma). These harmful effects can be prevented by introducing branched chain amino acids (leucine, isoleucine, valine), which can block the harmful effects of aromatic amino acids and their metabolites on the central nervous system (central nervous system). Thus, in the diet of hepatic patients, the amount of aromatic amino acids should be reduced as much as possible, and branched chain amino acids should be increased. In practice, it is required that the so-called “Fischer ratio” (J. Fischer), that is, the ratio (Val + Lei + Ile) / (Tyr + Trp + Fen) be greater than 4. This cannot be achieved using only natural food proteins (milk , soy, etc., as well as their hydrolysates). The amino acid composition of the product must be corrected by adding free branched crystalline amino acids. However, this creates a number of problems in the production of the product - high osmolarity, poor taste, poor emulsification of fat.

In the fat component of this product, which contains a medium chain triglyceride fraction and safflower oil, there is a large excess of omega-6 polyunsaturated fatty acids (polyunsaturated fatty acids) and omega-3 polyunsaturated fatty acids, which can cause lipid metabolism disorders and further impair liver function. The carbohydrate component is represented by maltodextrin, sugar, fructose. The use of sugar is undesirable because of the possibility of overloading the insulin apparatus of the pancreas in patients weakened due to the underlying disease, sugar and fructose increase the osmolarity of the mixture, which can cause diarrhea. In a product of this type, this is especially critical, since the osmolarity of the product is already very high due to the presence of a high concentration of free amino acids.

The mineral composition of the product is unsuitable for hepatic patients because of the very high sodium content (overstatement of at least 5 times for these patients), potassium, zinc, with a very low (inadequate) iron content. A high content of mineral salts leads to excessive fluid intake, which in turn can lead to impaired fluid removal from the body of patients with liver failure and to the development of ascites (dropsy). A lack of iron in the diet of a patient with liver failure can cause anemia.

The vitamin composition does not meet the needs of patients suffering from liver failure. The content of vitamins A, E, K, C, Bs (folic acid) is excessive in comparison with the needs of liver patients and can, with prolonged use of the product, cause them to further deteriorate liver function. The above disadvantages do not allow the use of the product for patients with liver diseases.

The closest in technical essence and the achieved result to the claimed technical solution is the milk product Nutrihep ^® (Nutrhep ^® ), manufactured in Switzerland by Nestle, containing a whey protein concentrate, a mixture of branched chain amino acids (isoleucine, valine, leucine), a medium chain triglyceride fraction ( represented by fractionated coconut oil), rapeseed oil (canola oil), corn oil, emulsifier (lecithin), modified corn starch, mineral salts of potassium, sodium, magnesium, calcium oia, copper, manganese, iodine, zinc, fat-and water-soluble vitamins and water [2].

Nutrigep is a lactose-free mixture of oral and tube nutrition for sick children older than 3 years old and adults suffering from liver diseases.

The protein component of the product is represented by a mixture of whey protein and branched chain amino acids (leucine, isoleucine, valine), selected in such a way that the ratio of the content of branched chain amino acids to the content of aromatic amino acids (the so-called Fisher ratio) exceeds 4. This prevents the development of liver failure, the accumulation of aromatic amino acids in the blood and the resulting damage to the central nervous system (the so-called hepatic coma). The disadvantage of this protein component is that a high consumption of whey proteins of milk, which are allergenic, can cause allergic sensitization, especially with prolonged consumption of the product and (or) with its probe administration.

The fat component of this product includes a large amount of medium chain triglycerides (the amount of medium chain triglycerides fraction is 66%). This can have a side effect on the central nervous system due to the passage of fatty acids through the blood-brain barrier.

Fractionated coconut oil is the main source of medium chain triglycerides in this product. At the same time, certain amounts of higher saturated and unsaturated fatty acids may be present in it. Excessive saturated fatty acids with a large chain length can adversely affect lipid metabolism in patients (increase in total cholesterol, cholesterol in low-density lipoproteins, serum triglycerides), which can create an additional risk of developing atherosclerosis. The fat component of this product includes corn and low eruca rapeseed oil. The use of corn oil due to the extremely low content of ω3 polyunsaturated fatty acids is undesirable, since ω3 fatty acids are necessary for the regeneration of cells (tissue), especially the nervous system, immune system, and have anti-inflammatory effects, which is important for those weakened due to liver disease sick. To compensate for the low level of ω3 PUFA in corn oil, this product has to use too much low erucic rapeseed oil (to balance the fatty acid composition of the ω6 and ω3 series), which makes the product more expensive. At the same time, even this type of rapeseed oil contains certain amounts of erucic acid, which adversely affects cholesterol metabolism, which in turn is not indicated for patients with concomitant cardiovascular diseases.

The use of modified starch as a carbohydrate component is dictated by the need to reduce the osmolarity of the product, however, on the other hand, the use of this component is undesirable, as it leads to a deterioration in the digestibility of carbohydrates (causes excessive growth of conditionally pathogenic microflora in the intestine), and a deterioration in the organoleptic properties of the product when taken orally (taste worsens), causes an increase in the viscosity of the product, which complicates its introduction through the probe, impairs the solubility of the product.

There are no mineral salts of selenium, molybdenum, chromium in the product. This can lead to a deterioration in the status of these elements in patients with prolonged consumption of the product. Which in turn can lead to increased peroxidation in the tissues of the liver and impaired glucose tolerance.

All of the above reduces the nutritional value of the product, the quality of the product, worsens the organoleptic and dietary properties of the product, can cause problems (adversely affect health) for long-term use of the product by chronic patients, especially with probe administration, that is, this product cannot be used for preventive purposes.

The technical result of the claimed invention is to increase the nutritional value of the product, giving the product prophylactic properties, improving the quality and dietary properties of the product.

The technical result is achieved by the fact that the enteral nutrition product, including whey proteins, amino acids 1-isoleucine, 1-leucine, 1-valine, a source of carbohydrates, a source of medium chain triglycerides, rapeseed oil, emulsifier, mineral salts, vitamins and water, additionally contains oil soybean, moreover, a medium chain triglyceride concentrate is used as a source of medium chain triglycerides, and maltodextrin and sugar are used as a source of carbohydrates, and the mass ratio of the medium chain concentrate is trigitseridov, rapeseed and soybean oil, respectively, is 2: 1: 1, with the following component ratio, wt% (on dry substance).:

Whey Protein Concentrate 6.60 ÷ 7.50 L-leucine 2.75 ÷ 3.13 L-Isoleucine 1.54 ÷ 1.75 L-Valine 1.21 ÷ 1.38 Maltodextrin 59.9 ÷ 68.9 Sugar 4.77 ÷ 8.89 Medium Chain Triglyceride Concentrate 4.84 ÷ 5.58 Rapeseed oil 2.42 ÷ 2.79 Soybean oil 2.42 ÷ 2.79 Emulsifier 0.017 ÷ 0.020 Mineral salts 1.960393 ÷ 2.731228 Vitamins 0.13 ÷ 0.27 Water Rest

The claimed technical result is achieved by a combination of the following factors:

- the use of a whey protein concentrate (in the claimed amounts) allows to achieve a high biological value of the protein component of the product (and hence the product itself) and to provide the patients need for essential amino acids in conditions when the total protein content in the product (in accordance with the needs of the liver patients) is low;

- the use of soybean oil (instead of corn) allows you to provide the patient with the need for essential PUFAs of the ω6 family and part of the need for essential PUFAs of the ω3 family, thereby reducing the proportion of low-eric rapeseed oil in the product, which, in turn, reduces the cost of the product and reduces it the concentration of unhealthy erucic acid;

- the introduction of a medium chain triglyceride concentrate (SCT) into the product can improve the digestibility of the fat component and the product as a whole in patients with impaired digestive function due to improved intestinal emulsification and absorption of fat in conditions of insufficient digestive factors: pancreatic lipase, phospholipids and bile acids of bile. SCT concentrate is a product of a strictly defined composition, in which there are practically no higher saturated fatty acids, leading to an increased risk of atherosclerosis;

- the use of a composition of maltodextrin and sugar allows you to provide the patient's energy needs while maintaining the product good organoleptic properties (taste), good solubility, without a significant increase in the osmolarity of the mixture;

- the introduction into the product of amino acids (leucine, isoleucine, valine) allows you to block the harmful effects of aromatic amino acids (phenylalanine, tyrosine and tryptophan) and their metabolites on the central nervous system;

- the introduction of mineral salts of selenium, molybdenum, chromium into the product allows you to protect the patient's body from the harmful effects of lipid peroxidation products, normalize the state of carbohydrate metabolism, and increase glucose tolerance.

The total protein content (in the protein component) represented by whey protein and a mixture of crystalline L-amino acids in the product is, based on the protein equivalent, 10.8-12.2% by weight of the dry product. Exceeding this value is undesirable, as it will lead to an unacceptable increase in the intake of protein nitrogen for liver patients, which will cause an increase in the ammonia content in the blood and worsen the general condition of the patient’s body. Reducing the protein content in the product below the specified range will lead to the fact that patients will not be adequately provided with essential amino acids, as a result of which their deficiency will develop and their health will worsen.

With an increase in the content of any of the three free amino acids over the claimed amount (while maintaining their total amount in total), the quota of two other amino acids decreases, which leads to insufficient provision of the patient. When lowering the quota of each of the amino acids below the claimed amount (while maintaining their total amount in total), the patient's security with this amino acid worsens. With an increase in the total amount of free amino acids in relation to KSB, firstly, the osmolarity of the product increases, which impairs its digestibility and can cause diarrhea. Secondly, the supply of patients with other essential amino acids that make up KSB (such as methionine, lysine, threonine) is unacceptably worsening. Thirdly, the taste of the product is greatly deteriorated, which makes its consumption in the form of a drink unacceptable. With an increase in the quota of KSB in comparison with free amino acids, the Fisher ratio decreases below 4, that is, the content of aromatic amino acids increases unacceptably, which can cause deterioration of liver function and damage to the central nervous system. With an increase in the total protein quota (over 12.2% in protein equivalent), the intake of total nitrogen is unacceptable for patients, which can cause further deterioration of liver function and poisoning of the body by protein breakdown products (ammonia, etc.). With a decrease in the protein quota below 10.8% in the protein equivalent, it is impossible to satisfy the patients' need for most of the essential amino acids needed to restore the body's proteins, which can lead to the breakdown of muscle protein and worsen the condition of patients.

The fat component of the claimed product is represented by a mixture of a medium chain triglyceride concentrate, soybean and rapeseed oil, taken in a mass ratio of 2: 1: 1, respectively.

In contrast to the fat component of the prototype, the claimed product uses soybean oil instead of corn, which contains significant quantities of polyunsaturated fatty acids of the ω3 series necessary for the regeneration of tissues of the nervous and immune systems, especially the nervous system. The ratio 2: 1: 1 is due to the fact that the ratio (mass) of medium-chain triglycerides to long-chain triglycerides (their source of soybean and rapeseed oil) should be 1: 1 - for optimal absorption of fat in the intestines of the patient, and therefore the product itself. An increase in medium chain triglycerides of more than 50% can cause a violation of the central nervous system. The content of medium-chain triglycerides of less than 50% can lead to insufficient absorption of fat in the intestines of the patient. The mass ratio of 1: 1 between low eruca rapeseed and soybean oils is caused by the need to maintain a balance between polyunsaturated fatty acids of the ω6 and ω3 series: the ratio of ω6 / ω3 in the claimed product is 4.2: 1. This provides a sufficient amount of w3 PUFA necessary for tissue regeneration and stimulating the activity of the immune system, and ω6 PUFA involved in the synthesis of series 4 prostaglandins, which are necessary to maintain the normal barrier function of the gastric mucosa and small intestine, as well as arachidonic acid, which is an important component part of cell membranes and some important intracellular mediators. An increase in the proportion of rapeseed oil in the product over the claimed amount will lead to insufficient supply of ω6 PUFA necessary for the patient to maintain normal barrier function of the gastric mucosa and small intestine, as well as other epithelial barriers, and can also lead to activation of undesired lipid peroxidation processes in the patient’s body and in the product itself during storage. The consequence of the latter may be a deterioration in the organoleptic properties of the product (the appearance of rancid taste) and a reduction in the warranty period. An increase in the proportion of rapeseed oil can also cause the accumulation in the product of certain amounts of erucic acid, which is unfavorable for patients suffering from atherosclerosis and cardiovascular diseases. In addition, an increase in the content of low erucic rapeseed oil greatly increases the cost of the product.

With excess, over the claimed ratio, the amount of soybean oil in the product, the intake of essential PUFA of the ω3 family, which has anti-inflammatory activity and contributes to the maintenance of normal immunity function, decreases.

The carbohydrate component is represented by maltodextrin and sugar, which improves the taste of the product in comparison with the prototype, which can be significant when patients use the product in the form of a drink.

In the claimed product, maltodextrin and sugar are taken in a mass ratio of 7.3: 1 ÷ 13.3: 1, respectively. Deviation from this ratio of less than 7.3: 1 is undesirable, since an increase in the sugar component of the carbohydrate component leads to an increase in the osmolarity of the mixture, which can adversely affect the absorption of the product in the intestine. In addition, an excess of sugar creates an additional burden on the insulin apparatus of the pancreas, which may adversely affect the condition of patients weakened due to the underlying disease. Deviation from this ratio to a side of more than 13.3: 1 is undesirable, since an increase in the proportion of maltodextrin in the carbohydrate component worsens the taste of the product, which makes it difficult for patients to use it as a drink.

In comparison with the prototype, the use of mineral salts of selenium, chromium, molybdenum in the product normalizes the state of carbohydrate and energy metabolism in patients, and also helps to protect their body from the harmful effects of free radicals and peroxide compounds.

Preparations of vitamins and minerals are made taking into account the needs of the human body in these nutrients per 1 unit. energy value according to the "Norms of physiological needs for nutrients and energy", approved by the Ministry of Health of the USSR in 1991

The components in the product are introduced in ratios that ensure a balanced intake of all nutrients into the body when using the product as the sole source of nutrition.

The claimed combination of features allows you to get a milk product of enteral nutrition with increased nutritional value, improved quality and organoleptic properties, improved dietary properties, and also allows you to give the product preventive properties (in comparison with the prototype) by optimizing, first of all, the qualitative composition of fat and carbohydrate component, the quality of the vitamin and mineral complex, as well as the amount of protein component used. Deviations to a greater or lesser extent from the declared values lead to a decrease in both the nutritional value of the claimed product and its quality, organoleptic and dietary properties, and do not allow the product to be used for preventive purposes.

Nutrien Hepa Enteral Nutrition Product is produced from:

- whey protein whey protein concentrate with a mass fraction of protein of at least 80%, approved by the bodies of the State Sanitary and Epidemiological Supervision of the Ministry of Health of Russia for use in the production of baby food;

- amino acids - L-isoleucine, L-leucine, L-valine;

- maltodextrin with a dextrose equivalent of 6-8 DE obtained from genetically unmodified raw materials approved by the bodies of the State Sanitary and Epidemiological Supervision of the Ministry of Health of Russia for use in the production of baby food;

- sugar;

- soybean oil in accordance with GOST 7825-76, refined deodorized with a peroxide value of not more than 2 mmol of active oxygen / kg, obtained from genetically unmodified raw materials approved by the bodies of the State Sanitary Inspection of the Ministry of Health of Russia for use in the production of baby food;

- refined deodorized rapeseed oil with an erucic acid content of not more than 5% of the sum of fatty acids, with a peroxide number not exceeding 2 mmol of active oxygen / kg, approved by the bodies of the State Sanitary and Epidemiological Supervision of the Ministry of Health of Russia for use in the production of baby food;

- a medium chain triglyceride concentrate authorized by the bodies of the State Sanitary and Epidemiological Supervision of the Ministry of Health of Russia for use in the production of baby food;

- lecithin (emulsifier) obtained from genetically unmodified raw materials authorized by the bodies of the State Sanitary and Epidemiological Supervision of the Ministry of Health of Russia for use in the production of baby food;

- Ascorbed palmitate allowed by the bodies of the State Sanitary Epidemiological Supervision of the Ministry of Health of Russia for use in the production of baby food.

Vitamins are used: retinol acetate (vitamin A acetate) according to FS 42-3029-94, or a solution of retinol acetate in oil 3.44% and 8.60% according to FS 42-3183-95, or retinol palmitate (vitamin A palmitate) according to VFS 42-2229-94, or a solution of retinol palmitate in oil 55% according to FS 42-1875-95; cholecalciferol (vitamin D ₃ ) pharmacopoeial quality; α-tocopherol acetate (vitamin E acetate) according to VFS 42-2442-94 or according to VFS 42-1642-81; phylloquinone (vitamin K ₁ ); ascorbic acid (vitamin C) according to FS 42-2668-95; nicotinamide (vitamin PP) according to the GF USSR-X Art. 452 or nicotinic acid (vitamin PP) according to FS 42-2357-94; thiamine hydrochloride (vitamin B ₁ ) according to the State Pharmacopoeia of the USSR-X century 674 or thiamine bromide (vitamin B ₁ ) according to FS 42-2413-92; riboflavin (vitamin B ₂ ) according to FS 42-2954-93; calcium pantothenate (vitamin B ₃ ) according to FS 42-2530-95; pyridoxine hydrochloride (vitamin B ₆ ) according to the GF USSR-X century 567; cyanocobalamin (vitamin B ₁₂ ) according to FS 42-2518-94; folic acid (vitamin B) according to VFS 42-2479-95; biotin (vitamin H); choline chloride according to FS 42-1997-93, or choline dihydrocytrate or bitartrate. Instead of vitamins, a vitamin premix can be used (if available), approved by the bodies of the Sanitary Inspection of the Ministry of Health of Russia for use in the production of baby food (includes vitamins A, D, E, K ₁ , C, PP, B ₁ , B ₂ , B ₃ , B ₆ , B ₁₂ , Bc, H).

Use mineral salts: sodium chloride according to GOST 4233-77; potassium chloride according to GOST 4234-77, potassium citric acid according to GOST 5538-78 or according to OST 10 289-01; calcium phosphoric acid according to GOST 3204-76; potassium phosphoric acid according to GOST 2493, magnesium chloride according to GOST 4209-77; zinc sulfate according to GOST 4174-77; copper sulfate according to GOST 4165-78; iron sulfate according to GOST 4148-78; manganese chloride according to GOST 612-75; potassium iodide according to GOST 4232-74; chromium chloride according to GOST 4473-78; ammonium molybdenum acid in accordance with GOST 3765-78; sodium selenite, sodium bicarbonate according to GOST 2156-76, first grade; citric acid according to GOST 3652-69 or food citric acid according to GOST 908-79E, Extra grade or premium; potassium hydroxide according to GOST 24363-80; drinking water according to SanPiN 2.1.4.1074-01. Instead of mineral salts, a mineral premix may be used, approved by the bodies of the State Sanitary and Epidemiological Supervision of the Ministry of Health of Russia for use in the production of baby food (includes manganese chloride, potassium iodide, ferrous sulfate, zinc sulfate, copper sulfate, chromium chloride, ammonium molybdate, sodium selenite).

It is allowed to use similar types of domestic and imported components with a quality not lower than the above.

The main raw materials and components of domestic production and obtained by import in terms of safety indicators must meet the requirements of SanPiN 2.3.2.1078-01 (index 3.6, as for baby food).

Mineral salts according to microbiological indicators must meet the requirements of SanPiN 2.3.2.1078-01 (index 3.6.10.2).

A method of obtaining the claimed product is carried out, for example, as follows.

The dry whey protein concentrate is dissolved in a continuous circulation mode in drinking water with a temperature of 43 ÷ 47 ° С until an aqueous solution with a mass fraction of solids of 4 ÷ 5% is formed, cooled to a temperature of 2 ÷ 6 ° С and kept with constant stirring 2 ÷ 2, 5 hours

Then the proteins are treated with salts, for this, potassium citric acid is dissolved in drinking water with a temperature of 15 to 20 ° C until a solution with a mass fraction of salts of 9 ÷ 10% is obtained and mixed until completely dissolved.

The resulting solution is added with stirring to a cooled KSB solution, maintained with constant stirring for 30–40 min (the active acidity of the resulting protein mixture is 6.7–7.0).

Preparation of a protein-carbohydrate mixture

Maltodextrin and sugar are dissolved in a protein mixture, heated to a temperature of 58 ÷ 62 ° C, and mixed for 20 ÷ 30 minutes.

The protein-carbohydrate mixture is pasteurized at a temperature of 76 ÷ 80 ° C with an exposure of 15 ÷ 17 s and cooled to 2 ÷ 6 ° C.

Preparation of an oil-vitamin mixture

Soybean and rapeseed oil and a medium chain triglyceride concentrate are pumped into the reservoir for the preparation of an oil-vitamin mixture, add fat-soluble vitamins A, D ₃ , E, K ₁ and lecithin, previously dissolved in 0.5-1.0 kg of soybean oil, and mix 10 ÷ 15 minutes

Ascorbyl palmitate is dissolved in soybean oil in a ratio of 1:35 at a temperature of 95 ÷ 100 ° C and stirred for 10 ÷ 15 minutes. The resulting solution is introduced into an oil-vitamin mixture preheated to a temperature of 60-65 ° C, stirred for 10-15 minutes and sent to prepare the emulsion.

Preparation of a normalized mixture

Protein-carbohydrate mixture and oil-vitamin mixture in a ratio of 10: 1, heated to a temperature of 60 ÷ 65 ° C, are sent to emulsification and homogenization.

Homogenization is carried out at a pressure in the first stage of 120 ÷ 130 kgf / cm ² and in the second stage of 45 ÷ 55 kgf / cm ² . The normalized mixture should have fat globules with a diameter of not more than 5 microns and not form clusters.

The normalized mixture is pasteurized at a temperature of 74 ÷ 78 ° C with a holding time of 29 ÷ 31 s, cooled to a temperature of 2 ÷ 6 ° C.

Potassium phosphoric acid, calcium phosphoric acid, potassium chloride and sodium chloride are dissolved in drinking water with a temperature of 15 to 20 ° C until a solution is obtained with a mass fraction of salts of 10 to 15%, stirred until complete dissolution and introduced into a normalized mixture at constant stirring.

Ascorbic acid (vitamin C), which is used to dissolve iron sulfate, is dissolved in drinking water with a temperature of 15 to 20 ° C until an aqueous solution with a mass fraction of acid from 0.01 to 0.02% is obtained, iron sulfate is added, and mixed until complete dissolution and contribute to the normalized mixture with constant stirring.

Zinc sulfate and magnesium chloride are dissolved in drinking water with a temperature of from 15 to 20 ° C until a solution with a mass fraction of salts from 2 to 3% is obtained, mixed until completely dissolved and introduced into a normalized mixture with constant stirring.

Manganese chloride, copper sulfate are dissolved in drinking water with a temperature of 15 to 20 ° C until a solution is obtained with a mass fraction of salts of 2 to 3%, mixed until completely dissolved and introduced into a normalized mixture with constant stirring.

Ascorbic acid (vitamin C) is dissolved in drinking water with a temperature of 15 to 20 ° C until an aqueous solution with a mass fraction of vitamin 2 to 3% is obtained, mixed until completely dissolved and vitamins PP, B ₁ , B ₂ are added with constant stirring. In ₃ , ₆ , ₁₂ , mix until complete dissolution and bring into the normalized mixture with constant stirring.

Folic acid (Vitamin Bs) and sodium bicarbonate are dissolved in drinking water with a temperature of 15 to 20 ° C until an aqueous solution with a mass fraction of vitamin from 0.02 to 0.03% is obtained, then biotin and potassium iodide are added, mixed until completely dissolved and introduced with constant stirring into the tank with a normalized mixture.

Choline dihydrocytrate, or choline chloride, or choline bitartrate is dissolved in drinking water with a temperature of 15 to 20 ° C until an aqueous solution with a mass fraction of choline of 4 to 5% is obtained, stirred until complete dissolution and introduced into the normalized mixture with constant stirring.

Chromium chloride, ammonium molybdenum acid, sodium selenite are dissolved in drinking water with a temperature of 15 to 20 ° C until an aqueous solution with a mass fraction of salts of 3 to 4% is obtained, stirred until complete dissolution and introduced into the normalized mixture with constant stirring.

Amino acids - L-leucine, L-isoleucine, L-valine are dissolved in drinking water with a temperature of 15 to 20 ° C until an aqueous solution with a mass fraction of solids of 2 to 3% is obtained, mixed until complete dissolution and introduced into a normalized mixture at constant stirring.

The resulting normalized mixture is stirred for 20 ÷ 30 minutes The active acidity of the resulting normalized mixture is 6.7-7.0.

Thickening and drying

The normalized mixture is concentrated to a mass fraction of solids of 25 ÷ 45% and pasteurized at a temperature of 76 ÷ 80 ° C with an exposure of 45 ÷ 75 s.

Drying the condensed mixture is carried out under the following conditions:

temperature at the entrance to the drying tower - from 170 to 180 ° C;

the temperature at the outlet of the drying tower is from 75 to 85 ° C.

During the drying process, the resulting product is continuously discharged into the pneumatic transportation system, cooled, collected in containers and sent for storage, where it can be stored for no more than 48 hours. The finished product is sent for packaging.

The obtained dry milk product of Nutrien Hepa enteral and probe nutrition is a fine dry powder (lumps easily crumbled upon mechanical action) of a cream color. Taste and smell - specific, with a bitter taste; a slight taste of vegetable oil is allowed. The moisture content of the dry product ranges from 2 to 4%. In reduced form, the product is a homogeneous liquid without sediment.

As a concentrate of medium chain triglycerides, for example, Delios V product is used [3].

Chemical and physical data:

Parameter Specification Analysis Hue 5 1/4 " yellow ≤2 0.9 red ≤0.5 0.3 Acid number (mg KOH / g) ≤0.1 0,0 Iodine number (g I / 100 g) ≤0.5 0.02 Hydroxyl number (mg KOH / g) ≤5 3 Pericidal number (1/8 mmol O / kg) ≤0.5 0,0 Saponification Body (mg KOH / g) 330-345 336 Water (%) ≤0.1 0.02 Fatty Acid Distribution (%) C6 <2 <2 C8 55-65 55-65 C10 35-45 35-45 C12 <2 <2

As maltodextrin with a dextrose equivalent of 6–8 DE, for example, maltodextrin in the powder of Glusidex IT 8 or Glusidex 6 is used [4, 5].

Glucidex IT 8 is a mixture of food saccharides produced by controlled enzymatic hydrolysis and spray drying of edible corn starch and waxy corn starch.

SPECIFICATION: PHYSICAL AND CHEMICAL INDICATORS APPEARANCE MCL 086G White powder SMELL MCL 178D Neutral TASTE Neutral DRY LOSS MCL 002E 5% max CONTENT PROTEIN MCL 030A 0.15% max SULFURED ASH MCL 255A 0.1% max SO ₂ MCL 060P 20 ppm max. pH IN SOLUTION MCL 020B 4.5-5.5 DEXTROSE EQUIVALENT MCL 050B 7-10 BULK DENSITY MCL 095A 350 g / l approx. PARTICLE SIZE MCL 110A - RESIDUAL ON Sieve 250 MK 5% max - RESIDUAL ON Sieve 40 MK 95% min MICROBIOLOGICAL INDICATORS - TOTAL MMS 2002A 1000 / g max. - YEAST MMS 2003A 50 / g max. - MOLD MMS 2003A 50 / g max. - E. COLEY MMS2009A Absent in 10 g - SALMONELLA MMS 2010 Absent in 10 g - DISPUTES C.S.R. MMS 2015 50/10 g max TYPICAL PROPERTIES: CARBOHYDRATE COMPOSITION MCL 190A - Glucose 0.5% approx. - DISACHARIDES 1.5% approx. - HIGH POLYSACCHARIDES 98% approx. INORGANIC COMPOSITION: - SODIUM 50 ppm approx. - CHLORIDE 50 ppm approx. - CALCIUM 10 ppm approx. - POTASSIUM 10 ppm approx.

THE ENERGY VALUE, calculated on 100 g 1605 kJ (384 kcal) product being sold CONFORMITY: - US Federal Regulation Code 21CFR, 1994 § 184.1444. - FOOD CHEMICALS CODE, 4th edition. MCL, MMS: ROKETT Techniques

Glucidex 6 is a mixture of food saccharides produced by controlled enzymatic hydrolysis and spray drying of edible corn starch and waxy corn starch.

SPECIFICATION: PHYSICAL AND CHEMICAL INDICATORS APPEARANCE MCL 086G White powder SMELL MCL 178D Neutral TASTE Neutral DRY LOSS MCL 002E 6% max CONTENT PROTEIN MCL 030A 0.15% max SULFURED ASH MCL 255A 0.1% max SO ₂ MCL 060P 20 ppm max. pH IN SOLUTION MCL 020B 4.5-5.5 DEXTROSE EQUIVALENT MCL 050B 5-8 BULK DENSITY MCL 095A 450 g / l approx. PARTICLE SIZE MCL 110A - RESIDUAL ON Sieve 250 MK 10% max - RESIDUAL ON Sieve 40 MK 50% min MICROBIOLOGICAL INDICATORS - TOTAL MMS 2002A 1000 / g max. - YEAST MMS 2003A 50 / g max. - MOLD MMS 2003A 50 / g max. - E. COLEY MMS2009A Absent in 10 g. - SALMONELLA MMS 2010 Absent in 25 g. - DISPUTES C.S.R. MMS 2015 50/10 g max TYPICAL PROPERTIES: CARBOHYDRATE COMPOSITION MCL 190A - Glucose 0.5% approx. - DISACHARIDES 1% approx. - HIGH POLYSACCHARIDES 15% approx. MINERAL COMPOSITION: - SODIUM 50 ppm approx. - CHLORIDE 50 ppm approx. - CALCIUM 10 ppm approx. -POTASSIUM 10 ppm approx.

THE ENERGY VALUE, calculated on 100 g 1580 kJ (323 kcal) product being sold COMPLIANCE WITH STANDARDS: - U.S. Code 21CFR-1994 § 184.1444. - FOOD CHEMICALS CODE, 3rd edition. MCL, MMS: ROKETT Techniques

Example 1. For the preparation of 100 kg of a dry product of enteral nutrition, the starting components are taken in the following quantities, kg:

Whey Protein Concentrate 6.90 L-leucine 2.88 L-Isoleucine 1,61 L-Valine 1.27 Maltodextrin with Dextrose equivalent to 6 DE 64,4 Sugar 7.16 Medium Chain Triglyceride Concentrate 5.08 Rapeseed oil 2.54 Soybean oil 2.54 Lecithin 0.018 Potassium Phosphoric Acid 0.54 Calcium Phosphoric Acid 0.70 Potassium citric acid 0.21 Magnesium chloride 0.62 Sodium Chloride 0.19 Potassium chloride 0,048 Zinc Sulfate 0.014 Iron sulfate 0.016 Manganese chloride 0.0012 Copper sulfate 0.0013 Potassium iodide 0,000042 Sodium bicarbonate 0.00016 Lemon acid 0.00010 Sodium Selenite 0.000025 Ammonium Molybdenum Acid 0,000028 Chromium chloride 0.000032 Vitamin A 0,00039 Vitamin D ₃ 0.0000011 Vitamin E 0.0050 Vitamin K ₁ 0,000028 Vitamin C 0,040 Vitamin PP 0.0057 Vitamin B ₁ 0,00068 Vitamin B ₂ 0,00058 Vitamin B ₃ 0.0017 Vitamin B ₆ 0,00087 Vitamin B _c 0.000086 Vitamin B ₁₂ 0.0000012 Vitamin H 0,000046 Ascended palmitate 0.0024 Choline bitartrate 0.20 Water the rest is up to 100

The ratio of maltodextrin: sugar is 9: 1.

Example 2. To prepare 100 kg of dry enteral nutrition product, the starting components are taken in the following quantities, kg:

Whey Protein Concentrate 7.50 L-leucine 3.13 L-Isoleucine 1.75 L-Valine 1.38 Maltodextrin with Dextrose equivalent to 8 DE 61.3 Sugar 6.81 Medium Chain Triglyceride Concentrate 5.56 Rapeseed oil 2.78 Soybean oil 2.78 Lecithin 0,020 Potassium Phosphoric Acid 0.64 Calcium Phosphoric Acid 0.82 Potassium citric acid 0.24 Magnesium chloride 0.73 Sodium Chloride 0.21 Potassium chloride 0,054 Zinc Sulfate 0.016 Iron sulfate 0.018 Manganese chloride 0.0013 Copper sulfate 0.0015 Potassium iodide 0,000048 Sodium bicarbonate 0.00016 Lemon acid 0.00012 Sodium Selenite 0.000030 Ammonium Molybdenum Acid 0.000033 Chromium chloride 0.000037 Vitamin A 0,00039 Vitamin D ₃ 0.0000011 Vitamin E 0.0050 Vitamin K ₁ 0,000028 Vitamin C 0,040 Vitamin PP 0.0057 Vitamin B ₁ 0,00068 Vitamin B ₂ 0,00058 Vitamin B ₃ 0.0017 Vitamin B ₆ 0,00087 Vitamin B _s 0.000086 Vitamin B ₁₂ 0.0000012 Vitamin H 0,000046 Ascended palmitate 0.0027 Choline bitartrate 0.20 Water the rest is up to 100

The ratio of maltodextrin: sugar is 9: 1.

Example 3. To prepare 100 kg of dry enteral nutrition product, the starting components are taken in the following quantities, kg:

Whey Protein Concentrate 6.60 L-leucine 2.75 L-Isoleucine 1,54 L-Valine 1.21 Maltodextrin with Dextrose equivalent to 6 DE 66.7 Sugar 7.41 Medium Chain Triglyceride Concentrate 4.84 Rapeseed oil 2.42 Soybean oil 2.42 Lecithin 0.017 Potassium Phosphoric Acid 0.45 Calcium Phosphoric Acid 0.58 Potassium citric acid 0.19 Magnesium chloride 0.51 Sodium Chloride 0.16 Potassium chloride 0,043 Zinc Sulfate 0.012 Iron sulfate 0.013 Manganese chloride 0.0010 Copper sulfate 0.0011 Potassium iodide 0.000035 Sodium bicarbonate 0.00010 Lemon acid 0.000088 Sodium Selenite 0.000019 Ammonium Molybdenum Acid 0,000023 Chromium chloride 0,000028 Vitamin A 0,00024 Vitamin D ₃ 0.0000006 Vitamin E 0.0031 Vitamin K ₁ 0.000015 Vitamin C 0.015 Vitamin PP 0.0035 Vitamin B ₁ 0,00036 Vitamin B ₂ 0,00033 Vitamin B ₃ 0.0015 Vitamin B ₆ 0,00051 Vitamin B _s 0,000045 Vitamin B ₁₂ 0.00000067 Vitamin H 0,000029 Ascended palmitate 0.0023 Choline chloride 0.11 Water the rest is up to 100

The carbohydrate ratio of maltodextrin: sugar is 9: 1.

Example 4. To prepare 100 kg of dry enteral nutrition product, the starting components are taken in the following quantities, kg:

Whey Protein Concentrate 7.50 L-leucine 3.13 L-Isoleucine 1.75 L-Valine 1.38 Maltodextrin with Dextrose equivalent to 8 DE 59.9 Sugar 8.18 Medium Chain Triglyceride Concentrate 5.56 Rapeseed oil 2.78 Soybean oil 2.78 Lecithin 0,020 Potassium Phosphoric Acid 0.64 Calcium Phosphoric Acid 0.82 Potassium citric acid 0.24 Magnesium chloride 0.73 Sodium Chloride 0.21 Potassium chloride 0,054 Zinc Sulfate 0.016 Iron sulfate 0.018 Manganese chloride 0.0013 Copper sulfate 0.0015 Potassium iodide 0,000048 Sodium bicarbonate 0.00016 Lemon acid 0.00012 Sodium Selenite 0.000030 Ammonium Molybdenum Acid 0.000033 Chromium chloride 0.000037 Vitamin A 0,00039 Vitamin D ₃ 0.0000011 Vitamin E 0.0050 Vitamin K ₁ 0,000028 Vitamin C 0,040 Vitamin PP 0.0057 Vitamin B ₁ 0,00068 Vitamin B ₂ 0,00058 Vitamin B ₃ 0.0017 Vitamin B ₆ 0,00087 Vitamin B _s 0.000086 Vitamin B ₁₂ 0.0000012 Vitamin H 0,000046 Ascended palmitate 0.0027 Choline Dihydrocytrate 0.21 Water the rest is up to 100

The carbohydrate ratio of maltodextrin: sugar is 7.33: 1.

Example 5. To prepare 100 kg of dry enteral nutrition product, the starting components are taken in the following quantities, kg:

Whey Protein Concentrate 6.60 L-leucine 2.75 L-Isoleucine 1,54 L-Valine 1.21 Maltodextrin with Dextrose equivalent to 6 DE 65,2 Sugar 8.89 Medium Chain Triglyceride Concentrate 4.84 Rapeseed oil 2.42 Soybean oil 2.42 Lecithin 0.017 Potassium Phosphoric Acid 0.45 Calcium Phosphoric Acid 0.58 Potassium citric acid 0.19 Magnesium chloride 0.51 Sodium Chloride 0.16 Potassium chloride 0,043 Zinc Sulfate 0.012 Iron sulfate 0.013 Manganese chloride 0.0010 Copper sulfate 0.0011 Potassium iodide 0.000035 Sodium bicarbonate 0.00016 Lemon acid 0.000088 Sodium Selenite 0.000019 Ammonium Molybdenum Acid 0,000023 Chromium chloride 0,000028 Vitamin A 0,00024 Vitamin D ₃ 0.0000006 Vitamin E 0.0031 Vitamin K ₁ 0.000015 Vitamin C 0.015 Vitamin PP 0.0035 Vitamin B ₁ 0,00036 Vitamin B ₂ 0,00033 Vitamin B ₃ 0.0015 Vitamin B ₆ 0,00051 Vitamin B _c 0,000045 Vitamin B ₁₂ 0.00000067 Vitamin H 0,000029 Ascended palmitate 0.0023 Choline chloride 0.11 Water the rest is up to 100

The carbohydrate ratio of maltodextrin: sugar is 7.33: 1.

Example 6. To prepare 100 kg of dry enteral nutrition product, the starting components are taken in the following quantities, kg:

Whey Protein Concentrate 7.50 L-leucine 3.13 L-Isoleucine 1.75 L-Valine 1.38 Maltodextrin with Dextrose equivalent to 8 DE 63,4 Sugar 4.77 Medium Chain Triglyceride Concentrate 5.58 Rapeseed oil 2.79 Soybean oil 2.79 Lecithin 0,020 Potassium Phosphoric Acid 0.64 Calcium Phosphoric Acid 0.82 Potassium citric acid 0.24 Magnesium chloride 0.73 Sodium Chloride 0.21 Potassium chloride 0,054 Zinc Sulfate 0.016 Iron sulfate 0.018 Manganese chloride 0.0013 Copper sulfate 0.0015 Potassium iodide 0,000048 Sodium bicarbonate 0.00016 Lemon acid 0.00012 Sodium Selenite 0.000030 Ammonium Molybdenum Acid 0.000033 Chromium chloride 0,000037 Vitamin A 0,00039 Vitamin D ₃ 0.0000011 Vitamin E 0.0050 Vitamin K ₁ 0,000028 Vitamin C 0,040 Vitamin PP 0.0057 Vitamin B ₁ 0,00068 Vitamin B ₂ 0,00058 Vitamin B ₃ 0.0017 Vitamin B ₆ 0,00087 Vitamin B _s 0.000086 Vitamin B ₁₂ 0.0000012 Vitamin H 0,000046 Ascended palmitate 0.0027 Choline Dihydrocytrate 0.21 Water the rest is up to 100

The carbohydrate ratio of maltodextrin: sugar is 13.29: 1.

Example 7. To prepare 100 kg of dry enteral nutrition product, the starting components are taken in the following quantities, kg:

Whey Protein Concentrate 6.60 L-leucine 2.75 L-Isoleucine 1,54 L-Valine 1.21 Maltodextrin with Dextrose equivalent to 6 DE 68.9 Sugar 5,186 Medium Chain Triglyceride Concentrate 4.84 Rapeseed oil 2.42 Soybean oil 2.42 Lecithin 0.017 Potassium Phosphoric Acid 0.45 Calcium Phosphoric Acid 0.58 Potassium citric acid 0.19 Magnesium chloride 0.51 Sodium Chloride 0.16 Potassium chloride 0,043 Zinc Sulfate 0.012 Iron sulfate 0.013 Manganese chloride 0.0010 Copper sulfate 0.0011 Potassium iodide 0.000035 Sodium bicarbonate 0.00016 Lemon acid 0.000088 Sodium Selenite 0.000019 Ammonium Molybdenum Acid 0,000023 Chromium chloride 0,000028 Vitamin A 0,00024 Vitamin D ₃ 0.0000006 Vitamin E 0.0031 Vitamin K ₁ 0.000015 Vitamin C 0.015 Vitamin PP 0.0035 Vitamin B ₁ 0,00036 Vitamin B ₂ 0,00033 Vitamin B ₃ 0.0015 Vitamin B ₆ 0,00051 Vitamin B _s 0,000045 Vitamin B ₁₂ 0.00000067 Vitamin H 0,000029 Ascended palmitate 0.0023 Choline chloride 0.11 Water The rest is up to 100

The carbohydrate ratio of maltodextrin: sugar is 13.29: 1

The dry product obtained according to examples 1 ÷ 7, is a fine dry cream-colored powder with a specific bitter taste. The product is highly soluble in water, in reduced form it is a homogeneous liquid without precipitate, balanced in physicochemical composition and meets biomedical requirements. The product provides preventive nutrition in the form of a drink or an additive in food or enteral tube nutrition for children over 3 years old, as well as adults suffering from liver failure. The preventive effect of the product is achieved due to the optimally selected composition of the protein component (whey protein + branched chain amino acids) having a Fisher coefficient of at least 4 and present in the dry product in an amount of at least 10.8% and not more than 12.2% by weight , a fat component that provides patients with the delivery of essential polyunsaturated fatty acids of the ω3 and ω6 series in the optimal ratio, a carbohydrate component that provides sufficient energy value, acceptable osmolarity and satisfactory organoleptic properties of the product, balanced taking into account the needs of patients with hepatic insufficiency of the mineral and vitamin components.

Example 8. For the preparation of 100 kg of dry enteral nutrition product, the starting components are taken in the following quantities, kg:

Whey Protein Concentrate 6.90 L-leucine 2.88 L-Isoleucine 1,61 L-Valine 1.27 Maltodextrin with Dextrose equivalent to 6 DE 63.3 Sugar 8.75 Medium Chain Triglyceride Concentrate 5.08 Rapeseed oil 2.54 Soybean oil 2.54 Lecithin 0.018 Potassium Phosphoric Acid 0.45 Calcium Phosphoric Acid 0.57 Potassium citric acid 0.19 Magnesium chloride 0.51 Sodium Chloride 0.16 Potassium chloride 0,043 Zinc Sulfate 0.012 Iron sulfate 0.013 Manganese chloride 0.0010 Copper sulfate 0.0011 Potassium iodide 0.000035 Sodium bicarbonate 0.00016 Lemon acid 0.000088 Sodium Selenite 0.000019 Ammonium Molybdenum Acid 0,000023 Chromium chloride 0,000028 Vitamin A 0,00024 Vitamin D ₃ 0.0000006 Vitamin E 0.0031 Vitamin K ₁ 0.000015 Vitamin C 0.015 Vitamin PP 0.0035 Vitamin B ₁ 0,00036 Vitamin B ₂ 0,00033 Vitamin B ₃ 0.0015 Vitamin B ₆ 0,00051 Vitamin B _s 0,000045 Vitamin B ₁₂ 0.00000067 Vitamin H 0,000029 Ascended palmitate 0.0024 Choline Dihydrocytrate 0.20 Water The rest is up to 100

In the product obtained according to example 8, the ratio of carbohydrate components of maltodextrin: sugar is 7.23: 1, respectively. The use of this product is undesirable, as it can lead to excessive glucose in the patient’s blood and cause diarrhea.

Example 9. To prepare 100 kg of dry enteral nutrition product, the starting components are taken in the following quantities, kg:

Whey Protein Concentrate 6.90 L-leucine 2.88 L-Isoleucine 1,61 L-Valine 1.27 Maltodextrin with Dextrose equivalent to 6 DE 66,2 Sugar 4.95 Medium Chain Triglyceride Concentrate 5.08 Rapeseed oil 2.54 Soybean oil 2.54 Lecithin 0.018 Potassium Phosphoric Acid 0.64 Calcium Phosphoric Acid 0.82 Potassium citric acid 0.24 Magnesium chloride 0.73 Sodium Chloride 0.21 Potassium chloride 0,054 Zinc Sulfate 0.016 Iron sulfate 0.018 Manganese chloride 0.0013 Copper sulfate 0.0015 Potassium iodide 0,000048 Sodium bicarbonate 0.00016 Lemon acid 0.00012 Sodium Selenite 0.000030 Ammonium Molybdenum Acid 0.000033 Chromium chloride 0,000037 Vitamin A 0,00039 Vitamin D ₃ 0.0000011 Vitamin E 0.0050 Vitamin K ₁ 0,000028 Vitamin C 0,040 Vitamin PP 0.0057 Vitamin B ₁ 0,00068 Vitamin B ₂ 0,00058 Vitamin B ₃ 0.0017 Vitamin B ₆ 0,00087 Vitamin B _s 0.000086 Vitamin B ₁₂ 0.0000012 Vitamin H 0,000046 Ascended palmitate 0.0024 Choline bitartrate 0.20 Water The rest is up to 100

The product obtained according to example 9 is not suitable for consumption as a drink - very tasteless. The ratio of maltodextrin: sugar is 13.37: 1, respectively.

Clinical testing of the Entrien Hepa enteric product is currently underway.

Table 1 presents the chemical composition of the Nutrien Hepa product.

Table 1 The chemical composition of the Nutrien Gepa product The nutritional value: in 100 g of product in 100 ml of product, 1 kcal / 1 ml Calories, kcal 418 one hundred Protein equivalent, g eleven 2.6 Fat g 10 2,4 Carbohydrates, g 71 17 Minerals: calcium, mg 250 60 phosphorus mg 250 60 potassium mg 350 84 sodium mg one hundred 24 magnesium mg one hundred 24 copper, mcg 360 86 manganese, mcg 360 86 iron mg 3,5 0.8 zinc mg 3.6 0.8 chlorides, mg 400 96 iodine, mcg 36 8.6 chromium, mcg 7.0 1.7 molybdenum, mcg 17 4.0 selenium, mcg 17 4.0 Vitamins: retinol (A), mcg 209 fifty tocopherol (E), mg 2.1 0.5 calciferol (D), mcg 0.6 0.14 vitamin K, mcg fifteen 3.6 thiamine (B ₁ ), mcg 302 72 riboflavin (B ₂ ), mcg 350 84 pantothenic acid, mcg 1400 335 pyridoxine (B ₆ ), mcg 442 106 niacin (PP), mg 3,7 0.9 folic acid, mcg 47 eleven cyanocobalamin (B ₁₂ ), mcg 0.7 0.17 ascorbic acid (C), mg 17 4.1 biotin, mcg thirty 7.2 choline mg one hundred 24 Osmolarity, mOsm / l - 428

The inventive product is intended for consumption in the form of a drink or an additive in food and for enteral (probe) nutrition of children and adults suffering from:

- liver diseases, including the development of neurological symptoms; nutritional deficiency in chronic liver diseases; cholestasis or portal hypertension complicated by impaired absorption of fats; anorexia in the presence of liver failure; enteropathy and functional insufficiency of the gastrointestinal tract in patients with symptoms of liver failure; acute liver failure; chronic liver disease; chronic liver failure;

- the risk of developing postoperative multiple organ failure after surgery on the liver and digestive tract to prevent the development of this condition. Multiple organ failure is a severe systemic pathological condition that develops in patients as a result of severe stress, surgical trauma, burns, etc. and consisting in the loss of the protective barrier function of the mucous membrane of the small and large intestine against bacteria of the intestinal microflora. The preventive effect of the claimed product is determined mainly by a sufficient amount of protein with high biological value, the optimal ratio of PUFA, the presence of trace elements, especially zinc and selenium, as well as vitamins C and E, with antioxidant activity - all this together normalizes the trophic state of the thin epithelium intestines, prevents the development of peroxide processes in it and prevents an increase in intestinal permeability.

The product is used in the pre- and postoperative periods during surgical interventions on the liver, including liver transplantation; the product is also used if necessary for additional nutrition in patients with liver failure. The presence in the product in the optimal amount of protein with high biological value, essential branched chain amino acids, essential PUFAs of the ω3 and ω6 series in the optimal ratio, a complex of micronutrients with antioxidant activity, such as zinc, selenium, vitamins C, E, can improve the trophic state of the mucosa the shell of the small and large intestine and thereby reduce the risk of possible postoperative complications during interventions on the liver and other organs of the abdominal cavity. The composition of the claimed product optimally meets the needs of patients with hepatic insufficiency for all major macro- and micronutrients, which allows the claimed product to be used for a long time as a prophylactic measure for chronic patients (including with probe administration) as the main food product. The possibility of using this product for probe (intragastric and (or) intestinal administration) is determined by the low viscosity of the finished mixture, which allows it to easily pass through the probes of small diameter, and a sufficiently low osmolarity (despite the high content of free amino acids in the mixture), resulting in the risk of developing diarrhea with probe administration is minimized.

In the claimed product, the lactose content is less than 0.1%, i.e. This product can be used by patients with lactase deficiency (with a low-lactose or lactose-free diet).

The creation of this product allows you to expand the range of prophylactic products for enteral and oral nutrition of children and adults.

Information sources

1. ROSS MEDIKAL NUTRITIONAL SYSTEM. A total commitment to enteral nutrition. Product "Alitraq ^®" ( "Alitrak ^{®") ROSS PRODUCTS DIVISION ABBOTT LABORATORIES} . USA 1995, p. 4-5.

2. Enteral Product Guide. Nestle. Clinical Nutrition. Switzerland. 1996. Product "Nutrihep ^® " (Nutrigep ^® ), pp. 42-43 (prototype).

3. Product Delios V. Certificate of Analysis. Lot number GR01663221. Company GRÜNAU ILLERTISSEN GmbH. Germany. ILLERTISSEN, October 12, 2000, p. 1.

4. The product is glucidex IT8. Specification No. A99-208T10. Firm ROCKETT. France. Letrem. 10/08/1999, p. 1, 2.

5. Product glucidex 6. Specification No. L79-203K10. Firm ROCKETT. France. Letrem. 07.29.1999, p. 1, 2.

Claims (1)

Enteral nutrition product, including whey proteins, amino acids L-isoleucine, L-leucine, L-valine, carbohydrate source, medium chain triglyceride source, rapeseed oil, emulsifier, mineral salts, vitamins and water, characterized in that it additionally contains soybean oil, moreover, as a source of medium chain triglycerides use a concentrate of medium chain triglycerides, and as a source of carbohydrates - maltodextrin and sugar, and the mass ratio of the concentrate of medium chain triglycerides, rap ovogo and soybean oil, respectively, is 2: 1: 1, with the following component ratio, wt% (on dry substance).: Whey Protein Concentrate 6.60 ÷ 7.50 L-leucine 2.75 ÷ 3.13 L-Isoleucine 1.54 ÷ 1.75 L-Valine 1.21 ÷ 1.38 Maltodextrin 59.9 ÷ 68.9 Sugar 4.77 ÷ 8.89 Medium Chain Concentrate triglycerides 4.84 ÷ 5.58 Rapeseed oil 2.42-2.79 Soybean oil 2.42-2.79 Emulsifier 0.017-0.020 Mineral salts 1.960393-2.733128 Vitamins 0.13-0.27 Water Rest